| NPI | 1588638290 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 016047) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 016047-1) |
| Enumeration Date | 2006-02-17 |
| Last Update Date | 2020-01-28 |